Peritoneal mesothelioma is an extremely rare form of mesothelioma that affects the abdominal lining, or peritoneum. Caused by asbestos exposure, peritoneal mesothelioma can be difficult to diagnose because symptoms are not entirely unique to the disease, so a diagnosis has to be more than just what symptoms are observed. Through MRIs, CAT scans, biopsies, and other diagnostic procedures, peritoneal mesothelioma can be confirmed, but often times, the cancer is already in the advanced stages.
Treatment for peritoneal mesothelioma is difficult. There is no cure, and since the disease is typically in the later stages when diagnosed, traditional first line treatments such as chemotherapy can have little effect.
Hyperthemic Intraperitoneal Chemotherapy (IPHC) is a type of cancer treatment that is commonly used after surgical procedures known as “debulking” have attempted to remove all visible tumors for very advanced cases of cancer in the stomach. The cancer drugs are warmed and then inserted into the peritoneal cavity. The point of this direct infusion is to deliver higher concentrations of chemotherapy to the targeted idea to increase efficacy and decrease negative side effects.
Studies have shown that while IPHC has been found to prolong survival, it is also associated with significant morbidity and complications such as bleeding, infection, blood clots, and pneumonia arise from the surgery.
A recent study published in the Journal of Surgical Oncology investigated elevated brain natriuretic peptide (BNP) to determine the association between perioperative fluid status and major/cardiopulmonary (CP) complications following cytoreductive surgery (CRS) and IPHC. In this experiment that lasted from June 2014 to February 2016, 129 patients underwent the combination CRS and IPHC, with 16 of those patients having mesothelioma. Major complications occurred in 12% and thirty day mortality occurred in just two patients, (1.5%). After the first operative day elevated BNP levels correlated with increased risk of CP complications, especially in those received the chemotherapy treatment cisplatin. The study concluded that there are correlations between cardiopulmonary complications and elevated BNP levels. This means that BNP could be an early marker for risk complications for those suffering from peritoneal mesothelioma undergoing IPHC.
Determining risk factors helps limit complications that can arise from aggressive treatments so that alternative treatments may be administered to have the best possible outcome. The nature of peritoneal mesothelioma is uncompromising, and adverse effects from treatment are a matter of life and death. Scientists and researchers are hopeful that by identifying characteristics that may determine risk factors, negative side effects from the treatment can be avoided altogether.
Fisher SB, et al. “Elevated brain natriuretic peptide (BNP) is an early marker for patients at risk for complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC),” Journal of Surgical Oncology (2017 November 28). [Link]